Reuter Stefan, Reiermann Stefanie, Stypmann Jörg, Bautz Joachim, Schütte-Nütgen Katharina, Pavenstädt Hermann, Malyar Viola, Reinecke Holger, Kurosinski Marc-Andre, Görlich Dennis, Hense Hans-Werner, Suwelack Barbara, Schäfers Michael
Department of Internal Medicine D, University Hospital Münster, Münster, Germany.
Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany.
Clin Transplant. 2025 Feb;39(2):e70114. doi: 10.1111/ctr.70114.
The approach to cardiovascular risk assessment before renal transplantation is still controversial. Therefore, we evaluated and compared the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) who are candidates for kidney transplantation (KTx).
We prospectively enrolled 356 ESRD clinical transplantations for review, only patients (NCT01064674) admitted to our transplant center between August 2009 and July 2012. Cardiovascular risk assessment at the time of listing was based on the Münster Cardiovascular Risk Stratification Score (MCRSS), additionally including evaluation by DSE and MPS in all ESRD patients. Coronary angiography was conducted in patients at high risk according to the MCRSS and in those where noninvasive stress testing revealed stress-induced ischemia or wall motion abnormalities.
During long-term follow-up until October 2020, 2.43 cardiovascular events/100 person-years (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) occurred, and the overall patient survival was 71.9%. Mild perfusion deficits identified by MPS, unlike wall motion abnormalities detected by DSE, showed incremental prognostic value for event-free survival in patients with low MCRSS risk.
We therefore propose a modified MCRSS-based approach including MPS as a reasonable risk stratification approach for cardiovascular risk assessment of ESRD patients applying for KTx.
肾移植前心血管风险评估的方法仍存在争议。因此，我们评估并比较了心肌灌注显像（MPS）和多巴酚丁胺负荷超声心动图（DSE）在终末期肾病（ESRD）肾移植（KTx）候选患者中的预后价值。
我们前瞻性纳入了356例ESRD临床移植病例进行回顾，仅纳入2009年8月至2012年7月间入住我们移植中心的患者（NCT01064674）。列入名单时的心血管风险评估基于明斯特心血管风险分层评分（MCRSS），所有ESRD患者还额外包括DSE和MPS评估。根据MCRSS对高危患者以及无创负荷试验显示有负荷诱发的缺血或室壁运动异常的患者进行冠状动脉造影。
在截至2020年10月的长期随访期间，发生心血管事件2.43例/100人年（非致死性卒中、非致死性心肌梗死和心血管死亡），总体患者生存率为71.9%。MPS识别出的轻度灌注缺损，与DSE检测到的室壁运动异常不同，对低MCRSS风险患者的无事件生存具有递增的预后价值。
因此，我们提出一种基于MCRSS的改良方法，包括MPS，作为对申请KTx的ESRD患者进行心血管风险评估的合理风险分层方法。
